Background Neoplasms may cause joint symptoms by local compression of the primary tumor or metastases, or paraneoplastic syndrome. In some cases, they appear before thetumor diagnosis and would be helpful to have warning signs or symptoms.
Objectives Describe the presence of articular manifestations in later diagnosed cancer patients and their characteristics.
Methods Review of medical records of patients seen in outpatient oncology all along 3 years, which in the previous five years were assessed by locomotor symptoms related to subsequent cancer diagnosis.
Results 120 patients who met the inclusion criteria were identified. 73% were male and 27% female. 5% were under 30 years old, 30% 30-45 years, 45% 45-60 years, 15% between 60-75 years and 10% over 75 years. 10% of patients had more than 3 months of symptoms before being referred to a specialist, 60% between 3-6 months, 6-12 months 20% and 10% over 12 months. 100% of those under 35 years had more than 6 months of symptoms evolution. In 85% the primary tumor was detected and 15% were diagnosed of unknown primary cancer. Of these 45% had hematologic and 55% non- hematologic malignancies. Of the hematologic neoplasm, 20% were multiple myeloma, 15% leukemias and 5% lymphomas. In the group of solid tumors: 25% prostate, 15% breast, 15% renal, 12% lung, 8% colon, 5% gastric, 3% thyroid and 2% other tumors. Articular symptoms were due to bone metastasis in 100% of solid tumors. None primary bone tumor was descriibed. Generalized arthralgias without arthritis were observed exclusively in hematologic diseases. 45% had low back pain, 20% hip pain, 15% flank pain, 15% polyarthritis and 5% monoarthritis (90% knee). The locations most frequently affected by bone leisons were spine (50%), pelvis (25%), ribs (20%), skull (15%) and long bones (5%), femur and humerus. 96% of patients had multiple metastatic disease. The most frequently accompanying symptoms were weight loss of in 45% of cases, severe asthenia in 60% and fever in 35%. None was significantly related to a particular neoplasia, although 90% of patients which presented with fever were diagnosed of hematologic malignancy; in the remaining 5% fever was due to liver disease or infectious process companion. The most frequent causes of monoarthritis were breast and lung cancer, which together account for 60%. In the case of polyarthritis, leukemias and lymphomas were frecuently detected. For routine analytical performed, the 3 most commonly altered parameters were: anemia 65% in men and women 100%, being 75% lower 10g/dL HB; elevated ESR in 100% of cases, being greater than 80mm/1st h in 80% (<40 mm/1 st h 5%, 40-80 mm/1 st h 15%) and elevated alkaline phosphatase 75%, being higher in 500UI/ml in 75%, perhaps because of the highest percentage of males and prostate tumors. Simple Rx and/or bone scan radiography lead to diagnosis In 95% of case. Only in the remaining 5% cases CT or MRI was used to diagnose the cause of pain.
Conclusions The presence of persistent joint clinic over 3 months of unknown cause at any age accompanied by one or more of the following signs: ESR >80, Hb <10 FA >500 seems to be highly suggestive of occult cancer. A prospective study with more patients is necessary to confirm this hypothesis.
Disclosure of Interest None declared